You may not totally stop eczema flare-ups from occurring during vacations, but you can certainly reduce their frequency.

SHOULD your child have atopic eczema, special care and consideration must be taken whenever you plan a vacation.

There are a number of things that can be done to prevent a flare-up, and should one occur, you must be prepared beforehand to deal with it. Otherwise, you risk turning your vacation into a disaster.

Atopic eczema flare-ups may not have a clear-cut cause. Hence, it is especially important that you teach your child good skin care habits as part of their daily routine.

However, there are some additional precautions that need to be taken when you go on a family vacation. While these precautions may not totally stop eczema flare-ups, it does help reduce the severity and frequency of the flare-ups.

Holiday precautions

Atopic eczema, or atopic dermatitis, is a chronic skin condition. If you child has atopic eczema, his skin will become itchy, reddened, cracked and dry.

While atopic eczema typically affects children, it can also continue into adulthood, or it may start later in life.

The word eczema originates from the Greek word ékzema (which is derived from ekzein, which means "to boil out"). This was how ancient physicians described any fiery pustules on the skin.

So, what can you do to prevent flare-ups during a vacation? The first thing to do is to familiarise yourself with your child's condition in order to avoid the things that can cause a flare-up. You will need to know his sensitivities intimately if you are to avoid aggravating his condition.

Other precautions that you can take to minimise any potential flare-ups include the following:

These hotel rooms may be infested with house-dust mites that can aggravate atopic eczema.

·In hotter weather, you may find that a less greasy emollient will be better during the day as some children find a very thick greasy emollient makes them hot and itchy.

When used correctly as a daily skin care regime, emollients become effective "active" treatments. Emollient therapy is not just about products, but understanding how and when to use them.

·Ensure that your child drinks enough water. Always bring water with you to keep him hydrated.

·Bring your own towels. The towels provided by the hotel may be cleaned using harsh detergents that could potentially aggravate his sensitive skin.

·Bring your own bedding or get an anti-allergy travel bedsheet to place over the hotel's bed. This will reduce the possibility of harsh detergents, bed mites or any other allergens irritating his sensitive skin.

·Limit baths to 10 minutes. Bring and use your own soap/cleanser as the ones provided by the hotel may not suit his sensitive skin.

·Find out what types of food are available at your destination. This is especially important if he is allergic to certain foods (e.g. shellfish, seafood, etc) as it could cause a flare-up.

·Learn more about environmental factors. It is a good idea to be aware of things like temperature and humidity. Avoid extremely dry or hot places as it could lead to a flare-up. Even exposure to air-conditioning that is too cold for comfort can make your child's skin dry and aggravate his atopic eczema.

·Keep his skin moisturised as often as possible. Use any fragrance-free moisturiser to prevent skin irritation. Don't be afraid to apply it liberally and to reapply as often as needed.

·Pay careful attention to your child's skin care both before and after swimming. Chlorinated water can dry the skin and therefore, cause skin irritation. Ensure that you apply a thick layer of emollient before your child enters the pool to create a "chlorine barrier".

After your child is done with the pool, shower him pronto to rinse off the chlorinated water and apply more emollient once you have dried him off.

·Use the right type of sunscreen. Many sun creams will irritate the skin. Reading the ingredients list on the label is essential. You need to find one that is fragrance-free, protects against UVA and UVB, and is labelled hypoallergenic and paraben-free.

Testing a sun block should be done gradually, in advance of the holiday. Try it on an area of the child's eczema-free skin and expand the coverage area after a few hours if there's no reaction.

Generally, an SPF 30 or over is recommended for children. Put on the emollient, and then, put on sun protection around half an hour later (but before the child goes under the sun).

Reapply the sun block every two hours. Check with your dermatologist/paediatrician on which types to use.

Managing a flare-up

A lot of skin irritation is due to undertreated eczema rather than something in the sun block or an environmental factor making it worse, so make sure you treat your child's skin properly before you go away.

If your efforts to prevent a flare-up are unsuccessful, there are still some things you can do to mitigate the problem.

First of all, keep your child's skin properly moisturised. This will help minimise the itch. There are many types of moisturisers, so pick one he is comfortable with.

Other things you can do to help your child manage his condition include:

·Keep eczema medication close at hand. If necessary, fill up small travel bottles with your child's eczema medication. This way, you can easily access it in case of any flare-ups during the flight or any part of your trip.

·Apply medication whenever necessary. Always bring your child's eczema medication with you on vacation. If you run out, make sure you know exactly what type of medication he uses so that you can get some from a nearby pharmacy.

·Use wet wraps to soothe itchy skin at night. Let him soak in a lukewarm bath for around 10 minutes, then pat dry his skin before applying some moisturiser or medication. Moisten some clean gauze bandages with water and wrap the affected area. Next, cover it with a dry bandage/towel to help seal in the moisture.

·Use a cold compress for itch relief. To make a cold compress, just use a cold and damp piece of cloth. Alternatively, you can wrap an ice pack or a cold canned/bottled drink in a soft towel.

·Wear loose-fitting and comfortable clothing. Pick cotton or cotton-blends, and avoid wool or other synthetic materials that could further irritate the skin.

Whether your child's eczema flares up during your vacation is not an issue. What's important is that you are ready for it and go for your holiday prepared, fully equipped to deal with any contingencies.

In this way, you will be able to fully enjoy your vacation.

> This article was provided in conjunction with National Eczema Awareness Month 2014, supported by a grant from A. Menarini Sdn Bhd.

I'M not proud to say that Malaysians are a seriously overweight and obese lot.

According to the World Health Organisation (WHO) Non-Communicable Disease Country Profile in 2011, Malaysians are the most obese amongst citizens of South-East Asian countries.

Our penchant for nasi lemak, roti canai and char koay teow explains why a staggering 44% of all Malaysians have a body mass index (BMI) of over 25, which is the criteria for being classified as overweight or obese.

The fact that most of us avoid exercise like the plague does not help matters.

It's human nature to opt for the easy way out, which is why weight and fat loss treatments are amongst our local aesthetic clinics' most sought after procedures.

An affordable, effective way of shedding the pounds is to take appetite suppresants containing phentermine. Phentermine is the active ingredient of a well-known brand of diet medicine.

This United States Food and Drug Authority (FDA) approved medicine is also a controlled item, meaning the patient would need to consult with a medical doctor each and every time before getting the prescription.

Phentermine works by reducing one's appetite. That fragrant, mouth-watering fried chicken will suddenly seem less appetizing.

Those on phentermine might find themselves satiated, and even full, with a few spoonfuls of rice, whilst previously, they could easily wolf down a fourth helping at the buffet restaurant.

Since he or she is consuming much fewer calories, the body will utilise the person's fat storage as fuel due to the calorie deficit.

I have seen clients losing eight kilograms, or even more, monthly when they are on phentermine. The heavier the person is to begin with, the more pounds he or she will lose when on this prescription drug.

Before starting the potential patient on this medicine, the friendly neighbourhood doctor will first take a complete medical history to ascertain that there are no contraindications such as heart disease, uncontrolled high blood pressure, pregnancy or breastfeeding.

Those who are only slightly overweight are not suitable for this drug, as dieting and exercising alone will probably reduce those extra few kilos.

Next, the physician will conduct a thorough physical examination. The patient's weight, waist measurement, body fat percentage and blood pressure is recorded during each visit.

Instead of getting the patient to just completely rely on the medicine, we doctors would advise the patient about healthy eating habits and exercise routines. The results are much better if our clients are committed to helping themselves in the long run.

Most doctors will give a month's supply of phentermine to their patient and get them to come back for subsequent monitoring.

We would track the patient's weight loss progress regularly, besides ensuring that he or she does not have intolerable side effects, such as hand tremors, palpitations, insomnia, feeling thirsty or mood swings.

Additional phentermine may be prescribed if the patient needs to lose more weight.

Losing weight is not the most difficult part of weight loss; maintaining the result after stopping the drug is.

Once taken off the medicine, appetite goes back to normal and it may be difficult for some to resist the temptation of that heavenly buffet spread or the latest delicacy, especially after being deprived of such tantalizing yummies for a period of time.

We remind our patients that they will need to continue practising healthy eating habits and slog away at the threadmill regularly even after discontinuing the medicine to maintain the results.

Some clients are keen to lose their belly, love handles and back fat bulges, but are not keen to go under the knife. Liposuction may give excellent, significant results, but it comes with the risk of anaesthesia, scarring, discomfort, swelling and time taken off from regular daily activities or work.

Wearing a stifling compression garment for the subsequent months may also not be some people's cup of tea.

An exciting development in non-invasive body contouring and fat loss is selective radiofrequency. Called Vanquish, this machine was launched last year to many good reviews by clients.

Numero uno: According to WHO, we're the fattest nation in South-East Asia. - WHO

The Vanquish system is a non-invasive, non-contact procedure that heats fat over the treated area at a temperature of 40-45°C.

At this temperature, the fat cells are damaged and undergo a process called apoptosis, or programmed cell death, whilst the surrounding tissue remains unaffected.

Fat cells that reach and maintain the desired therapeutic temperature will slowly die off within the next few months and be removed by the body's immune system.

The result is a safe and natural decrease in the adipose tissue layer.

The procedure is done once a week for at least four sessions. Each session takes half an hour and covers the tummy and love handles or the back.

Clinical studies show that the Vanquish procedure produces visible, measurable results with high client satisfaction.

The technology is suitable for those who are of normal weight or slightly overweight individuals who have pockets of fat that are resistant to exercise and dieting.

For example, many ladies develop an unsightly pouch below the belly button after pregnancy. Men may notice love handles, which simply refuse go away when they are middle-aged.

These are examples of ideal candidates for this new radiofrequency treatment. The Vanquish is not a weight-loss procedure as one will not lose many pounds. Rather, it is an "inch-loss" or body-contouring procedure.

Phentermine and Vanquish are just examples of the various fat reduction methods that aesthetic doctors can employ. Many new fat-busting technologies are being developed as we speak, and a day may come in the future when everyone can afford to look fabulously slim if they so desire.

Enough of writing from me this time. Now hand me that awesome bar of Kit Kat.

> Dr Chen Tai Ho is an experienced aesthetic doctor who chills by the pool sipping expresso latte when he's not attending to his beloved patients. For further information, e-mail starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader's own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

We assume that healthcare institutions have their patients' best interests at heart; here are some of the guidelines and laws that back that assumption up.

MOST of us would probably have heard the stories of emergency patients being turned away from private hospitals because of their critical conditions or lack of financial guarantees, or the overflowing wards in public hospitals leading to patients having to sleep in camp beds along aisles or corridors.

Hospitals were created to treat and nurse the ill back to health, but sometimes it may feel like that original objective has been displaced by the competing interests of being a business, or lack of resources, among others.

So, how do the public know that their welfare and safety are really being put first in these healthcare institutions?

One way, of course, is through government policies.

According to the Association of Private Hospitals of Malaysia (APHM) chief executive officer Dr T. Mahadevan, quality in healthcare was first spelt out in the Fourth Malaysia Plan (1981-1985) as an activity of the Health Ministry (MOH).

This resulted in the launching of the Quality Assurance Programme (QAP), which still serves as a national benchmark for patient safety and quality healthcare in all MOH hospitals, in 1985.

Dr Mahadevan, who was one of two presenters at the Understanding Accreditation and the Relevance of the Patient Safety and Quality Improvement Movements session during the "Overcoming Challenges to Quality Improvement and Patient Safety Strategies" workshop held in Kuala Lumpur recently, notes that, "Surprisingly, we were one of the few countries at that time to do it."

The QAP covers around 145 public hospitals with a total of about 39,500 beds nationwide.

However, this still leaves out the three university-affiliated hospitals under the Higher Education Ministry, the three military hospitals under the Defence Ministry, health centres under the Housing and Local Government Ministry, Hospital Orang Asli Gombak under the Home Affairs Ministry, and around 220 private hospitals with about 10,500 beds in total around the country.

Practised by all

But there are certain quality assurance and patient safety activities that are practised by most, if not all, public and private hospitals.

These include the Maternal Mortality Review (MMR) and Perinatal Mortality Review (PNMR).

The MMR, also known as Confidential Enquiries into Maternal Deaths, was initiated in the early 1970s and looks at the causes of pregnancy-related deaths within the term of the pregnancy or within 42 days of the end of a pregnancy.

According to Dr Mahadevan, this is one of the strongest and longest-running patient safety activities in the country. This probably accounts for Malaysia's good maternal mortality ratio of only 29 deaths per 100,000 live births in 2010, decreased from 53 deaths in 1990.

Meanwhile, the PNMR analyses the reasons behind foetal and newborn deaths. Malaysia's neonatal mortality rate was three deaths in 1,000 live births in 2011, decreased from nine deaths in 1990.

In addition, Dr Mahadevan shares that the Peri-Operative Mortality Review (POMR), looking at deaths associated with surgical and surgery-related procedures done under general or regional anaesthesia, was initiated in 1990.

"But this has remained for public hospitals only; only MMR and PNMR has spread to both public and private hospitals," he says, adding that the POMR seems to have died a natural death in the private sector.

Aside from these specific inquiries, all hospitals in the country are obliged to do incident reporting.

An incident report is the immediate documentation of any unusual event in the healthcare facility, usually resulting in an injury.

However, in this case, the problem is the large amounts of information flowing in.

"The ministry is overwhelmed; there is a lot of information from the private sector, but it takes time to process it.

"Hopefully, it will be done, so we can all learn and improve," says Dr Mahadevan.

He adds: "People want to know happens after a report. Hospitals need to ensure that the results get back to the person who wrote the report."

Accreditation and the law

The other method of quality control is via accreditation through a relevant respected body.

In Malaysia, there are two widely-recognised bodies: the Malaysian Society for Quality in Health (MSQH) and the Joint Commission International (JCI).

The MSQH was set up by the APHM, MOH and the Malaysian Medical Association in 1997, while the JCI, an international American-based quality and patient safety best practices accreditation organisation, came into Malaysia a decade later.

Dr Mahadevan asked the workshop participants if any of them believed in accreditation, and the general murmurs seemed to indicate that it was a chore, more than anything else.

He affirmed the response, saying: "Accreditation is pursued not for improvement, but to put on the (hospital's) website."

However, he continues: "But I believe that after going through several rounds of accreditation, something good comes out of it."

According to him, there are 68 local MSQH-accredited public hospitals and 30 private ones, while the National Heart Institute (popularly known by its Malay acronym, IJN), along with seven private hospitals, have been accredited by the JCI.

"If you have MSQH or JCI, the framework (for quality assurance and patient safety) is there," he says.

However, Dr Mahadevan notes that, "Quality and patient safety is still very much management-driven, with minimal or nil clinician buy-in.

"It is management-driven because they got to say that we've got this programme in place." (See Triadic tension)

Other methods used to ensure patient safety include the Patient Safety Council of Malaysia, which oversees the implementation of the Malaysian Patient Safety Goals and is chaired by the Health director-general, as well as the following laws:

Dr Mahadevan notes that the Medical Act in particular, provides for the establishment of a National Specialist Register, a publicly-accessible database that is compulsory for all medical specialists practising in the country to be registered with.

"Hopefully, we will see this (completed) by the end of the year," he says.